Sunday, January 19, 2014

Doctors Under Siege--Dermatology

The vilification of physicians by the New York Times continues. In the past few months we have seen the specter of gastroenterologists, obstetricians, and emergency physicians being accused of greed and, well, more greed. They have been unfairly targeted as the drivers of exorbitant medical costs in this country. The spotlight now shines on the next medical specialty that will drive the downfall of American medicine--dermatology.

In today's issue of the Times, the paper attacks dermatologists for providing the life saving service of skin cancer removal. Specifically they target dermatologists for overcharging patients for Mohs surgery, a specialized procedure where skin cancers are meticulously removed thin layers at a time so that there is minimal cutting and scarring. The paper highlights the ordeal of one patient, Kim Little of Arkansas, who went to her dermatologist for removal of a basal cell cancer and wound up with medical bills of over $25,000. According to Ms. Little, her dermatologist took 15 minutes using Mohs to remove the tumor. He then directed her to another office for the wound to be closed by an ophthalmologist because it was close to her eye. There she was sedated by an anesthesiologist and given two dozen stitches on her cheek. Her bill included $1,800 for the Mohs, $14,000 for the plastic surgery, $1,000 for the anesthesia, and $8,700 for hospital charges. She claims she felt railroaded into undergoing such an extensive procedure for a small lesion and that she felt drowsy from the anesthesia for five days afterwards. She complains that she didn't feel like she had any choice except to accept what the doctors directed.

Oh my. These statements practically blame her doctors for fraud for charging so much money. It isn't until much later in the article does the paper say how much she ultimately paid for her care, $3,000 out of pocket according to her insurance policy. The piece doesn't bother mentioning that practically no one pays the full cost of a hospital bill. These bills are almost always negotiated down by insurance companies, as the ophthalmologist's 90% reduction in his charges attests to.

The Grey Lady blames dermatologists for stuffing their pockets by doing too many Mohs surgeries. It states that the number of Mohs has increased over 400% in the last decade. Never mind that people have been covering less and less of their bodies in public over the last few decades, leading to higher incidences of skin cancers. But it wasn't enough for the paper to blame dermatologists for America's high medical costs. They go on to wage class warfare by blaming all doctors who make more money than the paper's editors. Of course primary care doctors continue their saintly image by being the lowest paid physicians.

They don't begrudge the huge average salaries of spine surgeons, and neurosurgeons because they can only perform a couple of complex cases a day. They must work REALLY hard for their $800,000 plus annual income. The usual suspects are again indicted: the ROAD specialties. Dermatologists, ophthalmologists, (and gastroenterologists by default because of their high salaries), are accused of padding their incomes by performing multiple minor procedures a day, justified or not. Anesthesiologists and radiologists are lumped into this rogue's gallery of doctors mainly for what appears to be a humane lifestyle. In other words we don't work hard enough for our money. Apparently we specialty physicians fill the majority of seats on the AMA's review board on physician compensation while leaving the poor primary care doctors to pick up the crumbs.

Is it really a sin for doctors to make money? Nobody cares, and they even applaud, when internet companies produce thousands of millionaires practically overnight. Do most of those employees deserve that money? No. They just happened to luck into a job that was anointed the hot company on Wall Street. Meanwhile doctors, who are some of the smartest people in the country, are berated for using their smarts to make money taking care of patients instead of writing lines of code. We keep thousands of people employed at medical offices, hospitals, insurance companies, pharmaceutical companies, and myriad other industries. We don't just make our hard earned money to buy new toys.

The newspaper seems to feel that doctors should return to the age where we accepted chickens and homemade canned goods for compensation. If Bill Gates can have a net worth of over $70 billion for charging
money on computer software that is a necessity for almost all
computers in the world, well he is the smartest person on earth and
deserves his wealth. But it's just not fair that physicians should be making any kind of income on a service that should be universal and almost free of charge.